MEDICARE: JOAN EARL MCDEVITT LMSW/CQMHP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	6801085492	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	6801085492	OTHER	MI	MASTER'S SOCIAL WORKER LICENSE-CLINICAL LICENSE

General Provider Information

NPI Number	:	1083190805
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOAN EARL MCDEVITT LMSW/CQMHP

Provider Business Mailing Address
First Line	:	2126 TAMIE WAY
Second Line	:
City	:	JACKSON
State	:	MI
Zip	:	49203-3626
Country	:	US
Telephone Number	:	517-745-2458
Fax Number	:

Provider Business Practice Location Address
First Line	:	2126 TAMIE WAY
Second Line	:
City	:	JACKSON
State	:	MI
Zip	:	49203-3626
Country	:	US
Telephone Number	:	517-745-2458
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/15/2018
Last Update Date	:	07/15/2018

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